Current Status of Surgical Treatment of Well-Differentiated Thyroid Cancer

Thyroid cancer remains one of the most relevant challenges in contemporary endocrine surgery due to its increasing incidence, the high prevalence of well-differentiated forms, and persistent controversies regarding the optimal treatment strategies. The majority of cases consist of papillary and follicular thyroid carcinomas, which are generally associated with a favorable prognosis; however, they retain the capacity for regional metastasis and recurrence, underscoring the importance of determining the appropriate extent of surgery and the need for lymphadenectomy. Modern diagnostics for well-differentiated thyroid cancer are based on a combination of clinical examination, ultrasound imaging, and fine-needle aspiration biopsy (FNAB). Ultrasound imaging is the primary modality for initial visualization and risk stratification, while FNAB remains the principal method for preoperative morphological assessment of thyroid nodules. However, even with the use of contemporary diagnostic algorithms, challenges in the interpretation of cytological findings persist, particularly in cases of follicular neoplasms, which often necessitate surgical verification. Surgical treatment remains the principal method for radical intervention in thyroid cancer. The choice between hemithyroidectomy and total thyroidectomy remains controversial and should be individualized, considering the morphological subtype of the tumor, its size, localization, presence of multifocal growth, extrathyroidal extension, regional metastases, patient age, and risk factors for recurrence.

Minimally invasive, video-assisted, and endoscopic techniques are of considerable clinical interest due to reduced surgical trauma and improved cosmetic outcomes. However, their application in malignant tumors requires strict patient selection and careful evaluation, as technical advantages must not compromise the oncological radicality of the procedure. Among minimally invasive approaches, cervical mini-incision techniques and video-assisted procedures appear to be the most justified, while remote accesses techniques are associated with greater technical complexity, a larger dissection area, and limited oncological versality. Thus, thyroid cancer surgery continues to evolve actively; however, the choice of surgical extent and specific approach should be determined primarily by oncological appropriateness and safety considerations. Prospects for further advancements in treatment are linked to more precise risk stratification, standardization of diagnostic approaches, and accumulation of data on the long-term effectiveness of modern minimally invasive technologies.

1. Beltsevich D.G., Vanushko V.E. Actual questions for thyroid nodes diagnostic. Endocrine Surgery. 2014;8(3):5-13. (In Russ.) https://doi.org/10.14341/serg201435-13

2. Chernikov RA, Vorobiev SL, Sleptsov IV, Semenov AA, Chinchuk IK, Makarin VA, et al. Fine Needle Aspiration Biopsy of Thyroid Nodules: Diagnostic Value, Technical Aspects, Analysis of Results. Clinical and experimental thyroidology. 2013;9(4):31. (In Russ.) https://doi.org/10.14341/ket20139431-38

3. Semenov D.Yu., Saraisky M.I., Koloskova L.E. Combined analysis of BRAF-gene mutation and galectin-3 expression in preoperative diagnostics of thyroid cancer. Clinical and experimental thyroidology. 2011;7(2):49-56. (In Russ.) https://doi.org/10.14341/ket20117249-56

4. Chernikov R.A., Valdina E.A., Vorobjev S.L., et al. Long-term Results of Papillary Thyroid Cancer Treatment and Comparative Analisis of Various Treatment Strategies. Clinical and experimental thyroidology. 2014;10(1):31-37. (In Russ.) https://doi.org/10.14341/CET201410131-37

5. Chernikov R.A., Vorobjev S.L., Sleptsov I.V., et al. Results of Surgical Treatment of Papillary Thyroid Cancer. Clinical and experimental thyroidology. 2014;10(2):38-42. (In Russ.) https://doi.org/10.14341/CET201410238-42

6. Dzodzaeva A.V., Bondarenko E.V., Terekhova M.A., Vanushko A.V., Vanushko V.E., Troshina E.A. Current understanding of diagnosis, treatment and predictors of papillary thyroid microcarcinoma progression. Clinical and experimental thyroidology. 2024;20(3):14-20. (In Russ.) https://doi.org/10.14341/ket12813

7. Sleptcov I.V., Chernikov R.A., Novokshonov K.Yu., Sablin I.V., Pushkaruk A.A., Kantaria G.V., Tulanbaev J.T., Farafonova U.V., Feldsherov I.M. Tension-free thyroidectomy with medial access to the recurrent largeal nerves and thyroid vessels: methodology, results of application, advantages and disadvantages. Clinical and experimental thyroidology. 2024;20(2):5-14. (In Russ.) https://doi.org/10.14341/ket12793

8. Chevais A., Gadzhieva K.Sh., Slashchuk K.Yu., Bondarenko E.V., Ebzeeva A.K., Beltsevich D.G. Genetic diagnosis of hereditary and sporadic forms of medullary thyroid cancer: clinical importance and perspectives. Clinical and experimental thyroidology. 2025;21(1):30-41. (In Russ.) https://doi.org/10.14341/ket12832

9. Buyvalenko U.V., Levshina A.R., Sakhnova E.E. Alternative biomarkers of thyroid cancer. Clinical and experimental thyroidology. 2022;18(1):21-28. (In Russ.) https://doi.org/10.14341/ket12715

10. Troshina E.A., Terekhova M.A., Akhmatova R.R. Immunological aspects of papillary thyroid cancer. What’s new? Clinical and experimental thyroidology. 2020;16(4):14-18. (In Russ.) https://doi.org/10.14341/ket12695

11. Shabunin A.V., Dolidze D.D., Podvyaznikov S.O., et al. Features of thyroidectomy with central lymph node dissection through a reduced minimally invasive approach. Head and Neck Tumors. 2016;(1):46–54. (In Russ.)

12. Romanov I.S., Yakovleva L.P., Udintsov D.B., Sokorutov V.I., Ilkaev K.D. Evolution of surgical approaches in cervical lymph node dissections. Operative Surgery and Clinical Anatomy. 2023;7(2):55– 64. (In Russ.)

13. Romanchishen AF. Surgery of the Thyroid and Parathyroid Glands. A Guide for Physicians. St Petersburg: Vesti; 2009. (In Russ.)

14. Romanchishen A.F., Gostimsky A.V., Mosyagin V.B. et al. Surgical approaches in urgent and elective surgery of the neck. Khirurgiya. Zhurnal im. N.I. Pirogova. 2018;(5):75-80. (In Russ.) https://doi.org/10.17116/hirurgia2018575-80

15. Paches AI, ed. Head and Neck Tumors. Clinical Guide. Moscow: Prakticheskaya Meditsina; 2013. (In Russ.)

16. Vinogradov VV, Klochikhin AL, Reshulsky SS. Surgical approach for cervical lymph node dissection. Russian patent RU2570166C2; 2015. (In Russ.)

17. Pshenisnov KP, ed. Course of Plastic Surgery. A Guide for Physicians. In 2 vols. Yaroslavl; Rybinsk: Rybinsky Dom Pechati; 2010. 754 p. (In Russ.)

18. Kulakov AA, ed. Maxillofacial Surgery. National Guideline. Moscow: GEOTAR-Media; 2023. (In Russ.)

19. Dedov II, Melnichenko GA, eds. Endocrinology. National guideline. Abridged edition. Moscow: GEOTAR-Media; 2013. (In Russ.)

20. Rumyantsev PO, Ilyin AA, Rumyantseva UV, Saenko VA. Thyroid cancer. Moscow: GEOTAR-Media; 2009. (In Russ.)

21. Chernikov RA. Diagnosis, clinical and morphological features, and combined treatment of papillary thyroid cancer [dissertation abstract]. Moscow; 2014. (In Russ.)

22. Bagaturia GO. Combined and extended operations for locally advanced thyroid cancer [dissertation]. 2010. (In Russ.)

23. Chernikov RA. Surgical tactics in the treatment of papillary thyroid cancer [dissertation]. 2006. (In Russ.)

24. Smirnova V.A., Semkina G.V., Platonova N.M., Vanushko V.E. Papillary thyroid microcarcinoma. Clinical and experimental thyroidology. 2015;11(2):11-24. (In Russ.) https://doi.org/10.14341/ ket2015211-24

25. Boriskova M.E., Farafonova U.V., Pankova P.A., Bikov M.A., Ramazanova E.A. Surgical tactics optimization for treatment of BRAF positive papillary thyroid cancer. Clinical and experimental thyroidology. 2018;14(1):25-33. (In Russ.) https://doi.org/10.14341/ket9424

26. Bellantone R, Lombardi CP, Bossola M, et al. Video-assisted vs conventional thyroid lobectomy: a randomized trial. Arch Surg. 2002;137(3):301-305. PMID: 11888453. https://doi.org/10.1001/archsurg.137.3.301

27. Bilimoria KY, Zanocco K, Sturgeon C. Impact of surgical treatment on outcomes for papillary thyroid cancer. Adv Surg. 2008;42:1-12. PMID: 18953806. https://doi.org/10.1016/j.yasu.2008.03.001

28. Cibas ES, Ali SZ. The Bethesda System for Reporting Thyroid Cytopathology. Thyroid. 2009;19(11):1159-1165. PMID: 19888858. https://doi.org/10.1089/thy.2009.0274

29. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19(11):1167-1214. PMID: 19860577. https://doi.org/10.1089/thy.2009.0110

30. Horvath E, Majlis S, Rossi R, et al. An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management. J Clin Endocrinol Metab. 2009;94(5):1748-1751. PMID: 19276237. https://doi.org/10.1210/jc.2008-1724

31. Ito Y, Miyauchi A. Appropriate treatment for asymptomatic papillary microcarcinoma of the thyroid. Expert Opin Pharmacother. 2007;8(18):3205-3215. PMID: 18035964. https://doi.org/10.1517/14656566.8.18.3205

32. Ito Y, Higashiyama T, Takamura Y, et al. Risk factors for recurrence to the lymph node in papillary thyroid carcinoma patients without preoperatively detectable lateral node metastasis: validity of prophylactic modified radical neck dissection. World J Surg. 2007;31(11):2085-2091. PMID: 17885787. https://doi.org/10.1007/s00268-007-9224-y

33. Jo VY, Stelow EB, Dustin SM, Hanley KZ. Malignancy risk for fine-needle aspiration of thyroid lesions according to the Bethesda System for Reporting Thyroid Cytopathology. Am J Clin Pathol. 2010;134(3):450-456. PMID: 20716802. https://doi.org/10.1309/ajcp5n4mthpafxfb

34. Chao TC, Lin JD, Chen MF. Video-assisted open thyroid lobectomy through a small incision. Surg Laparosc Endosc Percutan Tech. 2004;14(1):15-19. PMID: 15259579. https://doi.org/10.1097/00129689-200402000-00004

35. Chew MH, Chan G, Siddiqui MM, et al. Risk-stratified management of well-differentiated thyroid cancers: a review of experience from a single institution, 1990-2003. World J Surg. 2008;32(3):386394. PMID: 18188642. https://doi.org/10.1007/s00268-007-9343-5

36. Kang SW, Jeong JJ, Yun JS, et al. Gasless endoscopic thyroidectomy using trans-axillary approach; surgical outcome of 581 patients. Endocr J. 2009;56(3):361-369. PMID: 19139596. https://doi.org/10.1507/endocrj.k08e-306

37. Alvarado R, McMullen T, Sidhu SB, Delbridge LW, Sywak MS. Minimally invasive thyroid surgery for single nodules: an evidence-based review of the lateral mini-incision technique. World J Surg. 2008;32(7):1341-1348. PMID: 18373119. https://doi.org/10.1007/s00268-008-9554-4

38. Benhidjeb T, Wilhelm T, Harlaar J, Kleinrensink GJ, Schneider TA, Stark M. Natural orifice surgery on thyroid gland: totally transoral video-assisted thyroidectomy (TOVAT): report of first experimental results of a new surgical method. Surg Endosc. 2009;23(5):1119-1120. PMID: 19263151. https://doi.org/10.1007/s00464-009-0347-0

39. Chen L, Wu YH, Lee CH, Chen HA, Loh EW, Tam KW. Prophylactic Central Neck Dissection for Papillary Thyroid Carcinoma with Clinically Uninvolved Central Neck Lymph Nodes: A Systematic Review and Meta-analysis. World J Surg. 2018;42(9):28462857. PMID: 29488066. https://doi.org/10.1007/s00268-018-4547-4

40. Ducoudray R, Trésallet C, Godiris-Petit G, Tissier F, Leenhardt L, Menegaux F. Prophylactic lymph node dissection in papillary thyroid carcinoma: is there a place for lateral neck dissection?. World J Surg. 2013;37(7):1584-1591. PMID: 23564213. https://doi.org/10.1007/s00268-013-2020-y

41. Sugitani I, Fujimoto Y, Yamada K, Yamamoto N. Prospective outcomes of selective lymph node dissection for papillary thyroid carcinoma based on preoperative ultrasonography. World J Surg. 2008;32(11):2494-2502. PMID: 18784956. https://doi.org/10.1007/s00268-008-9711-9

42. Calò PG, Medas F, Erdas E, et al. Role of intraoperative neuromonitoring of recurrent laryngeal nerves in the outcomes of surgery for thyroid cancer. Int J Surg. 2014;12 Suppl 1:S213-S217. PMID: 24862668. https://doi.org/10.1016/j.ijsu.2014.05.003

43. Wong KP, Mak KL, Wong CK, Lang BH. Systematic review and meta-analysis on intra-operative neuro-monitoring in high-risk thyroidectomy. Int J Surg. 2017;38:21-30. PMID: 28034775. https://doi.org/10.1016/j.ijsu.2016.12.039

44. Yang S, Zhou L, Lu Z, Ma B, Ji Q, Wang Y. Systematic review with meta-analysis of intraoperative neuromonitoring during thyroidectomy. Int J Surg. 2017;39:104-113. PMID: 28130189. https://doi.org/10.1016/j.ijsu.2017.01.086

45. Lang BH, Wong CK, Tsang JS, Wong KP, Wan KY. A systematic review and meta-analysis evaluating completeness and outcomes of robotic thyroidectomy. Laryngoscope. 2015;125(2):509518. PMID: 25236330. https://doi.org/10.1002/lary.24946

46. Kuba S, Yamanouchi K, Hayashida N, et al. Total thyroidectomy versus thyroid lobectomy for papillary thyroid cancer: Comparative analysis after propensity score matching: A multicenter study. Int J Surg. 2017;38:143-148. PMID: 27677707. https://doi.org/10.1016/j.ijsu.2016.09.083